Weighting Case Mix Groups: The Fatal Flaw in Resource Intensity Weights

1989 ◽  
Vol 2 (1) ◽  
pp. 8-11 ◽  
Author(s):  
Charles K. Botz
Keyword(s):  
Average Length ◽  
Case Mix ◽  
Average Length Of Stay ◽  
Fiscal Planning ◽  
Fatal Flaw ◽  
Important Relationship ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Related Group ◽  
Resource Intensity

Resource Intensity Weights (RIWs) for Case Mix Groups (CMGs) are calculated using American Diagnosis Related Group (DRG) weights and Canadian average-length-of-stay data. However, this calculation does not actually “Canadianize” DRG weights; it only serves to randomize them. This article demonstrates the lack of the all-important relationship between RIWs and CMG costs by using simplified graphical examples. Notwithstanding the deficiencies of RIWs, the concept of weighted CMGs is fundamentally sound. Accordingly, until MIS-level reporting is widely implemented and a sufficiently large and reliable domestic database has been accumulated, it may not be entirely inappropriate for Canadian health care institutions to use unadulterated American DRGs for case mix analysis and fiscal planning.

scholarly journals Psychiatric and substance abuse disorder diagnoses as predictors of length of hospital stay

1996 ◽  
Vol 19 (4) ◽  
pp. 20 ◽  
Author(s):  
David I Ben-Tovim ◽  
Rob Elzinga ◽  
Phillip Burgess
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Hospital Stay ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Length Of Hospital Stay ◽  
Classification Systems ◽  
Substance Abuse Disorder ◽  
Average Length Of Stay ◽  
Related Group

The mental health and substance abuse components of AN-DRG 3 were examinedusing data from all inpatient separations in two Australian States over a two-yearperiod. Assignment to a mental health or a substance abuse diagnosis related group(DRG) predicted about 20- per cent of the variability in average length of stay ofpatients treated for such conditions. Assignment to a substance abuse DRG was amuch less robust predictor of length of hospital stay than assignment to a mental healthDRG. There was little variation between years or States. Day-only intent patientswere excluded, as were long-stay outliers identified using an inter-quartile rangetrimming process. Psychiatric DRGs are similar to a number of other non-surgicallyfocused diagnosis related groups in their capacity to predict length of hospital stay. Theyare likely to remain an important component of casemix classification systems.

scholarly journals Structure of Neurological Departments in Germany: Results of the 12th Survey by the German Neurological Society

2017 ◽  
Vol 1 (02) ◽  
pp. E107-E116
Author(s):  
Michael Schroeter ◽  
Frank Erbguth ◽  
Reinhard Kiefer ◽  
Tobias Neumann-Haefelin ◽  
Christoph Redecker ◽  
...  
Keyword(s):  
Quality Management ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Neurological Society ◽  
Case Mix ◽  
Emergency Rooms ◽  
Drg System ◽  
Average Length Of Stay ◽  
Case Mix Index ◽  
Shortage Of Physicians

AbstractThe German Neurological Society has conducted a survey of the structure of neurological in-patient care every other year. The present survey covers the year 2015. With a response rate of 62% in mind, the questionnaire allowed meaningful comparisons to former surveys covering the years 2013 and 2011.Only a minority of departments maintains intensive care units of their own. In contrast, 24/7 presence of neurological physicians has become standard in interdisciplinary emergency rooms. Stroke management has made neurology increasingly involved in emergency care. Since 2015, thrombectomy has been recognized as state-of-the-art therapy for a subgroup of stroke patients, raising special demands for the availability of CT and MRI on a 24/7 basis. However, infrastructure did not improve as compared to former surveys.Number of beds, total procedures and average procedures per case proceeds (case mix, case mix index) has remained roughly unchanged. However, case numbers increased, and average length of stay robustly decreased within 2 years by 17% to 5.4 days.Staff structures were heterogeneous and were involved in various duties apart from inpatient care covered by the German Diagnosis-Related Groups (DRG) system. Departments did not succeed in differentiating expenditures related to the DRG system from other procedures. Shortage of nursing staff forced 22% of departments to temporally reduce services, 6% of departments did so because of a shortage of physicians, and in 2% of departments, both occurred. Departments were confident of certifications as means of quality management, and a few suggestions were provided for more meaningful parameters for outcome-oriented quality management in the future.

scholarly journals Economic impact of the Swiss Diagnosis-Related Group system on acute neurorehabilitation

2021 ◽  
Vol 10 (4) ◽  
pp. 10
Author(s):  
Loric Berney ◽  
Fabio Agri ◽  
Jean-Michel Pignat ◽  
Jean-Blaise Wasserfallen ◽  
Karin Diserens
Keyword(s):  
Economic Impact ◽  
Negative Impact ◽  
Average Length ◽  
Diagnosis Related Group ◽  
University Hospital ◽  
Accounting System ◽  
Financing System ◽  
Average Length Of Stay ◽  
Assessment Period ◽  
Related Group

Objective: To assess the economic impact of introducing the Swiss Diagnosis-Related Group (DRG)-financing system on the Acute Neurorehabilitation Unit (ANRU) of a University hospital in 2012 and to discuss the implications in 2020.Methods: A retrospective study using monocentric patient cohort and collecting anonymized data of consecutive patients admitted to the ANRU in 2012 and 2013. The characteristics, DRG A43Z, costs and revenues were retrieved from the hospital accounting system and allowed a comparison between the 2012 and 2013 groups of patients.Results: Forty-seven patients were included over the assessment period. In 2012, of the 23 patients admitted, 20 were coded A43Z, while in 2013, out of the 24 admissions, only eight had that specific code (p < .01). The average length of stay (LOS) increased from 45.5 days in 2012 to 49.5 days in 2013. Similarly, the average cost per patient increased by Swiss Franc (CHF) 19,994 over the two years, from CHF 183,634 in 2012 to CHF 194,629 in 2013. Finally, the average reimbursement per patient diminished by CHF 11,392, from CHF 193,153 in 2012 to CHF 181,760 in 2013.Conclusions: The negative impact on the cost–revenue balance is linked to both the increased cost of a longer stay and the decreased revenue due to less patients being coded A43Z. This study highlights the difficulties to justify funding of the complex care needed and to properly reflect patient burden in medico-administrative documents. Certainly, there is a need for a concerted effort to identify the services and resources needed within the DRG-system to guarantee the optimal management of acute neurorehabilitation.

Casemix and Affective Disorders: A Comparison of Private and Public Psychiatric Systems

1996 ◽  
Vol 30 (4) ◽  
pp. 511-515 ◽  
Author(s):  
Robert D. Goldney ◽  
Penny Kent ◽  
Robert H. Elzinga
Keyword(s):  
Length Of Stay ◽  
Affective Disorders ◽  
Average Length ◽  
South Australia ◽  
Psychiatric Hospitals ◽  
Diagnosis Related Group ◽  
Average Length Of Stay ◽  
Significant Difference ◽  
Private And Public ◽  
Related Group

Objective: To determine whether there is a difference in length of stay for patients with affective disorders between private and public psychiatric hospitals. Method: The casemix Australian national diagnosis-related group (AN-DRG) diagnoses of all inpatient separations from private and public psychiatric hospitals in South Australia for 1 year were abstracted from records. The average length of stay for patients with affective disorders was calculated. Results: There was no significant difference in the average length of stay for patients with affective disorders treated in private and public psychiatric hospitals. Conclusions: These results should allay fears that the treatment of patients with affective disorders in any particular treatment setting will be compromised by the introduction of casemix.

Resource Intensity Weighing and Case Mix Grouping: Assumptions and Implications for Health Service Performance Evaluation

1994 ◽  
Vol 7 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Christabel Chu
Keyword(s):  
Health Care ◽  
Performance Evaluation ◽  
Health Care Professionals ◽  
Cost Comparison ◽  
Case Mix ◽  
Management Tools ◽  
Canadian Health ◽  
Resource Intensity ◽  
And Performance ◽  
Categorization Scheme

The use of Resource Intensity Weights (RIWs*) for equity funding and utilization management assumes validity of the cost estimates, reliability of the patient categorization scheme, equivalence of the bases for cost comparison, and equity of the subsequent resource distribution. This paper examines these assumptions, and concludes that caution must be taken when using the current RIWs and Case Mix Groups (CMGs*) for resource allocation and performance evaluation purposes. RIW has represented a milestone in the history of Canadian health care product costing and management. It would be prudent for health care professionals at the operational level to provide structured and continuing feedback that can contribute to the validation and refinement of these valuable management tools.

The Canadian Health Care Conundrum

2008 ◽  
Vol 42 (5) ◽  
pp. 42
Author(s):  
BRYAN R. FINE
Keyword(s):  
Health Care ◽  
Canadian Health ◽  
Canadian Health Care

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

2020 ◽  
Vol 41 (S1) ◽  
pp. s403-s404
Author(s):  
Jonathan Edwards ◽  
Katherine Allen-Bridson ◽  
Daniel Pollock
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Average Length ◽  
Bloodstream Infections ◽  
Central Line ◽  
Significant Shift ◽  
Care Hospital ◽  
Average Length Of Stay ◽  
Period 2 ◽  
Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

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